GASTRO

Question 1

Gold standard for coeliac diagnosis

Who is referred for this

Answer 1

Biopsy
Jej or duodenum
Looks for villous atrophy. Also get lymphocyte infiltration

Referred if +ve TTG

Question 2

Most common extra intestinal feature of crohns and UC

Answer 2

arthritis

Question 3

What age group get Achalasia and what would make you think of it

Answer 3

Middle age
Difficulty swallowing liquid and food

Question 4

What would birds beak appearance indicate

Answer 4

Barium swallow - achalasia

Question 5

Adverse effects of Aminosalicylates

Answer 5

Agranulocytosis so need FBC.
If they’re allergic to aspirin they might also react to this.

Mesalazine carries 7x risk of pancreatitis

SulFAsalazine - fibrosis, anaemia (Heinz body), oligospermia,

Question 6

How to tell duodenal vs gastric ulcers on symptoms.

Answer 6

The pain associated with duodenal ulcers improves after meals
Pain associated with gastric ulcers generally intensifies after meals.

Question 7

Who does primary biliary cholangitis commonly affect
How does it commonly present
What was it previously called

Answer 7

Middle aged women

Itching in a middle aged woman

Previously primary biliary cirrhosis.

Can get jaundice and xanthomas

Question 8

What part of body is affected in primary biliary cholangitis and how

Answer 8

Interlobular bile ducts become damaged by a chronic inflammatory process ->cholestasis -> cirrhosis.

Question 9

What condition is associated with primary biliary cholangitis

Answer 9

Sjogrens

Question 10

What investigations to do for primary biliary cholangitis

Answer 10

anti-mitochondrial antibodies (AMA) M2 subtype present in 98%

smooth muscle antibodies in 30% of patients

raised serum IgM

Question 11

Management primary biliary cholangitis

Answer 11

first-line: ursodeoxycholic acid
slows disease progression and improves symptoms

pruritus: cholestyramine

fat-soluble vitamin supplementation

liver transplantation
e.g. if bilirubin > 100 (PBC is a major indication)

Question 12

Primary sclerosis cholangitis - what part of body is affected

Answer 12

inflammation and fibrosis of intra and extra-hepatic bile ducts.

Question 13

What disease is PSC associated with

Answer 13

UC

Question 14

How to investigate PSC and what might you see

Answer 14

MRCP/ERCP - beaded appearance (due to strictures)

Also p anca

Question 15

Complications of PSC

Answer 15

cholangiocarcinoma (in 10%)
increased risk of colorectal cancer

Question 16

Complications of PBC

Answer 16

HCC

Question 17

How to induce remission in Crohns

Answer 17

Steroids 1st line

2nd line mesalazine

Azathioprine or mercaptopurine can be used as an adjunct but not monotherapy

Question 18

How to maintain remission in Crohns

Answer 18

Azathioprine or mercaptopurine

Question 19

How to treat and investigate perianal fistulae in crohns

Answer 19

MRI
Metronidazole

Question 20

How to treat proctitis in UC

Answer 20

Rectal aminosalicyclates.

If no result after 4 weeks add an oral one

If still no result add topical/ oral steroid

Question 21

How to treat proctosigmoiditis and left-sided ulcerative colitis

Answer 21

1. Rectal aminosalicyclate
2. Either add oral aminosalicyclate OR oral aminosalicyclate and topical steroid
   3rd line. oral steroids/ oral aminosalicyclates only

Question 22

How to treat extensive UC

Answer 22

1. Topical aminosalicyclate plus a high dose oral one
2. If after 4 weeks no result stop topical and add oral steroids

Question 23

How to maintain remission in UC

Answer 23

Proctitis or proctosigmoiditis: oral or topical aminosalicyclates

If bad then oral aminosalicyclate

Question 24

When would you use azathioprine or mercaptopurine in UC?

Answer 24

Following a severe relapse or >=2 exacerbations in the past year

Question 25

how to monitor treatment in haemochromatosis

Answer 25

Ferritin and transferrin saturation

Question 26

Who gets prophylaxis for SBP
what is used

Answer 26

Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin

Question 27

What would an alcoholics AST:ALT ratio be like?

Answer 27

AST:ALT greater than 2

(salt before lime in tequila)

Question 28

What would NAFLD AST and ALT ratios look like?

Answer 28

ALT:AST ratio >2.

Question 29

How to tell whether LFTs Hepatitic or biliary probs

Answer 29

Hepatitic - raised ALT more than ALP

Biliary - Raised ALP.

Question 30

How can you tell if someone is having crohns flare (single best ix?)

Answer 30

Fecal calprotectin

Question 31

What can thiopurines increase risk of

Answer 31

Non melanoma skin ca

Question 32

What do you see in Gilberts

Answer 32

Increase in unconjugated bili

Causes a pre hepatic jaundice picture.

Question 33

How would you differentiate Gilberts from other causes of pre-hepatic jaundice?

Answer 33

No anaemia in Gilberts

Question 34

What is Budd Chiari syndrome?
Symptoms?
What would you see on MRI?

Answer 34

When you get obstruction to hepatic venous outflow.
Hepatomegaly, ascites, abdo pain.
Prominent caudate lobe.